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The Social Contract
The Social Contract is a 5th season episode of House which first aired on March 9, 2009. House and the team take on the case of Nick, a book editor who loses his inhibitions and starts insulting coworkers and clients at a dinner party one night before falling ill. The team realizes Nick has frontal lobe disinhibition, which has caused him to lose his filter and vocalize all of his innermost thoughts, resulting in extremely insulting outbursts. As Nick’s free speech lends to some amusing and insightful comments regarding the team, he must deal with the consequences of being unable to lie to his wife and everyone else important in his life. Meanwhile, House suspects Wilson and Taub are keeping something from him when he catches them both in a lie. House is determined to get to the bottom of it. Recap An author is having a party, but he's having trouble giving a speech. His editor starts making negative comments about his book. He says he doesn't know why he said it, but then he starts insulting people again. He's asked to be quiet, but he keeps going. Suddenly, he starts having a nosebleed and collapses. Cameron brings the case to House. The patient is suffering from frontal lobe disinhibition - he's unable to control what he says. House thinks it is a brain tumor, and Thirteen suggests it's in a nasal cavity. Taub and Kutner go to see the patient, Nick, who is still saying everything he thinks. Nick's daughter is getting in the way because she has an auditory processing deficiency. Nick makes a joke about Taub's nose. The wife is trying to arrange a breast cancer walk, and he starts insulting that too. She walks out. House invites Wilson to monster trucks, but Wilson declines, claiming he doesn't like monster trucks, that he only puts up with them for House. Kutner reports no tumor in the nose, but the patient will lose his wife if they can't fix him. They discuss whether Nick is truly nice or mean, and Kutner compares the choice to be nice to Harry Potter's desire not to placed in Slytherin House. Foreman and Thirteen start out with the patient, who can't stop talking graphically about how much he wants to have sex with Thirteen. When Cuddy walks in, the patient expresses his carnal desire for both, then waxes on about his preference for Cuddy and her impressive breasts. House was hiding in the control room with the lights out - he called Cuddy in to embarrass her. Before Cuddy boards an elevator, House tells her she should be flattered knowing the patient thought Cuddy was sexier than Thirteen. She chews him out publicly, but just before the elevator closes on her alone, she privately smiles. Foreman talks to Thirteen about whether she's upset that the patient preferred Cuddy. They start a brain scan and note that part of the brain isn't lighting up. They decide to start him on steroids to see if he improves. Taub asks Kutner if his nose really is too big. House joins Wilson in the cafeteria and tells him he has no core personality and he just tries to please who he's with at the time. House thinks he's still lying about monster trucks because he didn‘t write down the event in his appointment book but Wilson claims he is just playing racquetball with Taub that night. He didn't want to tell House since House can't play anymore. Nick doesn't improve on steroids and Foreman realizes his kidneys are failing and he needs dialysis. Taub thinks it might be a form of leukemia but his white blood cells count is normal. Taub tells House he's played racquetball with Wilson four or five times. House doesn't believe him. House wants to test the daughter for peripheral nerve damage and test the patient for glucose tolerance. He orders Taub to draw Nick's blood so he can't play racquetball with Wilson. He also tells Taub to admit he's lying. Kutner goes to test the daughter's nerves by alternatively using hot and cold to see if she can tell the difference. The wife is worried about what her husband is saying and what he must really think. The daughter doesn't react, then starts screaming. She got burned because she didn't tell Kutner that she felt the heat. She wanted to help her father. Taub is with the patient, who asks him to keep Thirteen away from him. He then realizes Taub has cheated on his wife and that everyone already knows. House pages Taub to the morgue to report. He wants to see Taub play racquetball. Taub starts playing. Nick's glucose response is normal but Taub still thinks it is an endocrine problem. Taub crashes into equipment chasing the ball and admits he never played racquetball with Wilson. However, House knew already, as he gave Taub a squash racquet. Kutner goes to do a thyroid scan but the patient wants to know why his daughter was burned. He thinks his daughter doesn't have an auditory disorder, she's merely below average. The daughter runs out of the room upset. The patient has a fever and his lungs are full of fluid. It appears the patient has an infection. However, the patient hasn't been out of the country and no one else is sick. House tells Kutner to get a better medical history anyway. Taub tells Wilson that House found out about the fake racquetball game and is trying to use him as a double agent. Kutner goes to examine the patient. The wife is there and the patient is afraid he's going to say something harsh again. Kutner reports to House that the patient’s medical history is boring but that the wife rescues dogs and he thinks it is Weil’s disease and House agrees. He orders antibiotics. Taub comes out with Wilson's emails, one of which is to an oncologist at New York Mercy. She's an expert in suicide in cancer patients. Taub asks House if he thinks Wilson might be suicidal but he dismisses the suggestion. The patient's fever and lung fluids start to improve, showing the infection is gone. However, the frontal lobe disinhibition appears to be permanent. Surgery is too dangerous because the affected part of the brain is too close to the brain stem. The patient throws them out. House wonders why Wilson was out walking. He lets him know he knows about New York Mercy. Wilson gets angry and tries to leave. House follows him, wondering why he didn't come back to get his coat when it was so cold out. In the cafeteria, Wilson, no longer able to cope finally snaps, stating that he wants some privacy, and one single thing about his life that goes unexamined by House. Wilson then storms out of the cafeteria, his outburst leaving House stunned. House arrives to see the patient in his office. He's angry that he's going home just to drive his family away. He asks House to operate but House points out the danger too. However, the patient would rather die than live as he is. He's always been impatient but he has worked at controlling it and now he doesn't want the lack of control. He doesn't like who he's becoming. House takes the case to Robert Chase so that he can talk to his boss, who is a neurosurgeon with an ego who might try the surgery. Chase wants to know why House cares. House tries to give excuses, but he finally admits he knows what it is like not to have any close friends and drive away anyone who cares. Chase agrees to help. They start the operation. As this happens, Wilson comes to see House in the observation lounge to apologize. House figured that Wilson lost someone, and that he's done more digging and discovered that Wilson’s homeless brother Danny Wilson is now in a psych ward. Wilson didn't tell House because it's likely House would remind him of how badly it could go. House admits he's right, and then offers to come along to be there for him if it goes badly. The patient goes to the recovery room. His heart and breathing are doing well on their own and he starts talking. However, despite successfully removing the damaged part of his brain, his disinhibition seems to remain unmitigated. In addition, his body temperature starts to drop and he goes into cardiac arrest. His wife walks out heartbroken over what he said about her. There is nothing wrong with the patient's heart, but his body temperature is out of control - it wasn't an infection. They can’t reach House. Foreman proposes a full body scan but the team points out how useless it is. Foreman wants to do it anyway. Wilson and House are waiting to see Danny. They talk about the last time Wilson saw him, 13 years before - a random sighting outside a deli where Wilson was eating. Wilson came to work in Princeton because that's where his brother was. The team reviews the scan. House is ignoring his calls. They feel they need to do targeted angiograms but it may take too much time. Taub sends a poorly autocorrected instant messenger message to House. House still wants to know why Wilson went outside without his coat. He thinks that Wilson wanted to know how his brother felt out in the cold, and that Wilson feels guilty. Wilson tells House about his brother's problems at Princeton University and how Danny would keep him busy for hours on the phone while Wilson was at medical school. One night, Wilson hung up on Danny so he could study and went to the library. The next day, Danny ran away and didn't take his medications with him. House says he shouldn't blame himself for just hanging up the phone. House realizes something about the patient - his glucose levels didn‘t change when he was on steroids, and they should have gone up. Wilson leaves to see his brother. The patient has Doege-Potter syndrome - an excess of human growth hormone from a benign fibroma that has caused an autoimmune condition. They mistook it for a cyst on the full body scan. If they take it out, he will return to normal. The patient improves and apologizes to Taub. Taub admits he does have a big nose. The patient's wife arrives to take him home. The patient is back to his old self, but there still appears to be some strain. House asks Wilson about his brother. Wilson will be seeing him again and asks House to meet him. Wilson realizes that he and his brother are now strangers to each other. Wilson admits he is careful around people but doesn't have to be careful around House. As they leave, Wilson says that he does like monster trucks. Major Events *House begins to wonder why Wilson is acting so secretively. *It's revealed that the secret Wilson is holding is that his long-lost homeless brother, Danny Wilson, is at New York Mercy receiving treatment for his schizophrenia. *Wilson reveals to House that he blames himself for his brother running away. Zebra Factor 9/10 Doege-Potter is very rare, with only about 200 cases ever being reported. Only about 1 in 25 tumors in the pleural cavity causes the condition. Trivia and Cultural Factors *The title refers to several social dynamics within the episode: **The dynamics between the patient, his family, his client, and his boss; **The dynamic of the relationship between House and Wilson; **People not mentioning Taub’s large nose, even though he’s a plastic surgeon; **Kutner’s difficulty with his bedside manner. *Phineas Gage is a famous case history from the mid-19th century who has been exhaustively studied for information about the function of the frontal lobes of the brain. He received an accidental frontal lobotomy in an explosives accident and thereafter his inhibitions seemed to evaporate. *The title refers to the social contract theory presented by philosopher Thomas Hobbes in his 1651 book Leviathan. Wherein he postulates that all members of society agree to limit their freedoms in order to be protected by said society as this leads to common goods within that society. *La bohéme is an opera by Puccini. *The Sorting Hat is a sentient hat in the Harry Potter series that sorts first-year students into their house at Hogwarts. Most famously, it was going to put Harry into Slytherin until Harry expressed a desire to be placed anywhere else. *Racquetball is played with a racquet that resembles a rounded equilateral triangle. Pay attention, Taub! Squash, on the other hand, is played with a racquet that resembles a long rounded isosceles triangle. *Wilson’s reference that his “Parents put me in the rocket” is a reference to the origin story of Superman. *Cyrano de Berkowitz is a reference to Cyrano de Bergerac, a real person whose life has now become largely fictionalized. Although an excellent swordsman, he was better known for his very large nose. In real life, de Bergerac’s nose was somewhat large but not as large as it is generally portrayed. House modifies the name to be Jewish when applying it to Taub. *House tries to make a big deal about Taub having no athletic talent in racquet sports because he’s Jewish (a common negative stereotype). However, Wilson is also Jewish. Moreover, we learn in season 7 that Taub is an excellent basketball player despite his short stature. *Sandy Koufax was a pitcher with the Brooklyn (later Los Angeles) Dodgers and is widely considered to be the best left-handed pitcher of all time. His career was cut short by chronic arm pain at the age of 30 but he still ranks 7th in total strikeouts. *House is still using MMBop as the ring tone for his team. *This episode raises the question of are we a random collection of neurological electrical impulses, or is the essence of a person something more than our brain cells. Cast * Hugh Laurie as Gregory House * Lisa Edelstein as Lisa Cuddy * Omar Epps as Eric Foreman * Robert Sean Leonard as James Wilson * Jennifer Morrison as Allison Cameron (credit only) * Jesse Spencer as Robert Chase * Peter Jacobson as Chris Taub * Kal Penn as Lawrence Kutner * Olivia Wilde as Remy Hadley * Jay Karnes as Nick Greenwald * Susan Egan as Audrey Greenwald * Darcy Rose Byrnes as Marika Greenwald * Devon Michaels as Timothy Moore * Jodi Harris as Elaine * Cyrus Daboo as Dr. Kapur * Sheri Foster as Cashier * Bobbin Bergstrom as Nurse * Carlos Arellano as Nurse Gonzales * Alan Mueting as Party Guest Links Episode page at IMDB Episode page at House MD Guide Episode review at Blogcritics Episode article at Wikipedia Episode page at The House Fan Quotes at House MD Quotes﻿ Category:Episodes Category:Season 5 Category:Zebra Factor 9